Saturday, August 31, 2013

WHO Confirms More MERS Cases; Bat Connection Questioned

MERS Deaths and Infections (chart)
Updated 08/31/2013
The World Health Organization has confirmed four previously reported cases of Middle East Respiratory Syndrome or MERS bringing the current total to 108 infections and 50 deaths, according to the Center for Infectious Disease and Prevention (CIDRAP). 

As previously reported, the four newest cases involve 55 and 38 year old men, both with underlying medical conditions and two family members who had been in close contact with the 38 year old, a seven year old girl and a sixteen year old boy, both without symptoms. (see Asymptomatic MERS Cases Reported in Saudi Children).

The mysterious virus, which was first recognized in Saudi Arabia last year, is a corona virus related to the common cold and a genetic cousin to SARS. It is believed to be carried by an animal host and tests of wild and domestic animals have been ongoing.

A similar strain was found in camels in Oman and Spain and a possible match from bat feces in Saudi Arabia, near the area of the original outbreak.

CIDRAP reports that questions about these possible intermediary hosts have been raised by scientists. Testing of camels in Saudi Arabia, ground zero for the outbreak, has not shown the virus in that population.

Genetic material collected from Egyptian Tomb Bat feces may not be a large enough sample to be sure it matches the MERS virus and not just a common sequence found in many viruses. Researchers feel that if the virus was active in the animal, higher levels would be present. Questions have also been raised about the collection and handling of the sample. For now, the search continues for the source for the virus and possible intermediary animal hosts.

Friday, August 30, 2013

Experimental Vaccine 'Neutralizes' MERS in Mice

MERS Coronavirus 
The American Society for Microbiology has reported a possible breakthrough in development of an experimental vaccine against the deadly MERS virus by a team of German and Dutch researchers.

The Middle East Respiratory Syndrome (MERS) virus has been confirmed in 104 cases on the Arabian Peninsula and Europe and is responsible for at least 49 deaths to date. The majority of victims were from Saudi Arabia or had recently traveled there.

The announcement was made in the Journal of Virology and states:
"Vaccinated mice produced high levels of serum antibodies neutralizing MERS-CoV. Thus, MVA-MERS-S may serve for further development of an emergency vaccine against MERS-CoV."
The new drug, MVA-MERS-S, is a combination of a weakened form of smallpox and a protein from the MERS Corona virus which allows the vaccine to bind to human receptors.

According to this article from The Children's Hospital of Philadelphia, this is just the first phase of a long process of testing and trials, licencing and manufacturing before a safe and effective vaccine can be mass produced.




Asymptomatic MERS Cases Reported in Saudi Children

August 30, 2013

In a statement from ProMed / International Society for Infectious Diseases, Saudi Arabia's Deputy Minister for Public Health has announced two new, asymptomatic (without symptoms) cases of Middle East Respiratory Syndrome, both family members of a 38 year old man who died on August 17 of MERS.

The newest cases are a 7 year old girl and a 16 year old boy. Previous reports have shown that in younger, healthier people, the MERS virus may be mild or asymptomatic.

In other news, the Saudi health official said a 55 year old man who was recently diagnosed with MERS appears to have had contact with one of the Qatari victims in a health care facility in Medina. The other infected man had not left Qatar. 

These and other recent cases have not yet been confirmed by WHO, but according to The Center for Infectious Disease and Policy (CIDRAP), they will bring the latest count of infections to 108 with 50 fatalities.  


Thursday, August 29, 2013

Progression of MERS Infections and Deaths Over Time (Chart)


For almost a year and a half, Middle East Respiratory Syndrome has been quietly spreading throughout several mid-eastern countries. First reported in early 2012 with the deaths of two Jordanian men and a man from Saudi Arabia, health officials have been tracking this slow moving virus as it gains momentum in the region.

Concerns are high that with millions of pilgrims from over a hundred countries who are expected to visit Saudi Arabia next month, the virus could be carried around the globe, resulting in a pandemic. Saudi Arabia is considered to be the source of the virus, with the vast majority of cases originating there.

This chart shows increases in the confirmed infection and death rates since the outbreak was first identified in early 2012.

Wednesday, August 28, 2013

MERS Claims More Victims in Saudi, UAE

The World Health Organization has been informed of eight more confirmed cases of MERS in Saudi Arabia. Five of those stricken were previously reported here (see Saudi MERS Deaths; Infections Continue to Rise, August 26, 2013), including one death.

Most of the stricken are from the Riyadh area, with two cases in Asir, in the southwest region of the country. One previously reported victim from the United Arab Emirates has died.

The three newest cases are all from Riyadh and involve 54 year old man with existing medical conditions who has passed away and two women, aged 50 and 59, both with prior medical conditions and both currently in intensive care.

In early July, 2013 WHO convened an Emergency Committee under the International Health Regulations (IHR). Between September 2012 and today, they have confirmed 102 MERS infections and 49 deaths.

WHO does not, as yet, consider the slowing spreading disease to be a public health emergency. Today's report concludes:
"...with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met."
WHO recommends health care workers remain vigilant and hospitals use infection prevention and control (IPC) techniques to prevent the spread to other patients, health care workers and visitors.

image from http://www.health.am

Monday, August 26, 2013

Qatar Reports Second MERS Infection This Week

Qatar's Supreme Council of Health (SCH) announced a fourth person has fallen ill with MERS in that country, the second this week alone.

The 29 year old man is in critical condition at the Hamad Medical Corporation hospital. According to the SCH, 104 cases have now been reported in the Middle East and Europe, with 49 deaths. Most of those stricken were from Saudi Arabia, totaling 82 confirmed ill and accounting for 41 fatalities.

This announcement continues a worrisome week in the Arabian Peninsula. In addition to the two new cases in Qatar, Saudi Arabia has reported two additional deaths and four new confirmed cases. Another sixteen suspected cases are as yet unconfirmed.

Saudi MERS Deaths, Infections Continue to Rise

August 26, 2013

MERS-CoV is from the family of viruses which cause the common cold
and is a genetic cousin to SARS
Health officials in Saudi Arabia have reported another MERS fatality and four new confirmed infections.  This is the second death in less than a week, bringing the total to 41 of 47 MERS deaths in hard hit Saudi Arabia. The latest fatality was a 51 year old man from Riyadh with cancer and other chronic health conditions.

Two of the new cases are from the southwestern region of the country. One is 31 year old man with previous illnesses and the other is a 55 year old man who was in close contact with an infected person. The second pair of infections are both from Riyadh, a 50 year old woman and a 70 year old man, both with chronic health conditions. Results are pending for sixteen more possible cases.

Margaret Chan, Director-General of the World Health Organization (WHO) called MERS her greatest concern and "a threat to the entire world." The spread of this genetic cousin to SARS has been slow but steady and, with a fatality rate of over 50%, the possibility exists for a dangerous global pandemic.

As deaths and infections continue to climb, health officials are worried about the millions of pilgrims from more than a hundred countries who will be traveling to Saudi Arabia for Haj in September and then returning home, possibly carrying the virus around the globe.

The Saudi government has issued regulations designed to contain the spread among crowds of religious pilgrims. Health officials are advising those who are over 65 or under 12 years old, chronically ill or pregnant to postpone the pilgrimage this year. They recommend common hygiene practices and vaccinations for influenza and pneumonia before entering the country.

Sunday, August 25, 2013

Dutch Patent Grab Blocks MERS Vaccine Research

As the middle east struggles to contain the deadly Middle East Repiratory Syndrome (MERS) virus, their efforts to find a vaccine are hampered by Erasmus Laboratory in Rotterdam Netherlands who patented the corona virus after receiving a sample from a Saudi researcher in 2012.

MERS has sickened at least a hundred people from the Arabian Peninsula to Europe and killed half that number. Saudi Arabia has been particularly hard hit, with the majority of illnesses and deaths linked to that country.

According to this article, H E Abdulaziz bin Sulaiman al Turki, Saudi Ambassador to Oman, complained that:

“We haven’t been able to go very far with diagnostics and finding a vaccine for the virus as of today. The main reason is that the virus was patented by a foreign laboratory and is not allowed to be used for investigations by other scientists...Intellectual property rights and patents should not stand in the way of public interest, especially when it concerns the health of a large number of people,”

The Director-General of the World Health Organization (WHO), Margaret Chan has assured Saudi Arabia she is looking into the matter and agrees that protecting it's citizens should be more important than intellectual property laws.

In this strongly worded response, Erasmus states it is not responsible for slowing research on the virus and other facilities are free to develop their own tests for exposure to MERS (but, evidently not vaccines or medicines.):

"The Viroscience Department of Erasmus MC strongly refutes all allegations concerning a presumed lack of willingness to cooperate in research into the new MERS coronavirus. The virus has already been sent free of charge to many public research and health institutions that can work with it safely and, like the Viroscience department, serve public health worldwide. It should be clear that a virus cannot be patented, only specific applications related to it, like vaccines and medicines. Rumours that the Viroscience department of Erasmus MC would hamper research into the MERS coronavirus are clearly wrong and not based on facts."

As concern grows for the millions of Hajj pilgrims who are expected to visit Saudi Arabia next month, researchers and health officials, with hands bound by patent laws, are left with little more than to advise the elderly and chronically ill postpone their trip, use common sense hygiene practices and vigilance by hospital and health care workers.

image from http://commons.wikimedia.org

Friday, August 23, 2013

Progression of Italian MERS Cluster Described

In this report, from Eurosurveillance, researchers took a close look at the development of the Italian cluster of MERS, starting with the first patient who had recently returned from the middle east.

The narrative begins on May 24, 2013 with a healthy man in his mid-40's who was preparing to return home following a 40 day visit to Jordan. He began to develop symptoms the day before he left and those continued through his flight home and through the 27th as he returned to work at an unnamed hotel.

His symptoms got worse, and on May 28, visited a hospital emergency room in Florence where he was admitted with pneumonia like symptoms. Following tests the next day, MERS was diagnosed by the Regional Reference Laboratory for Influenza at the University of Florence and later confirmed by the National Influenza Centre.

On May 29 the man's 18 month old niece developed mild symptoms and tested positive for MERS. They had spent all day together on May 26 and been in close contact.

On May 31 a co-worker began to show signs of influenza, with fever and cough. She was tested and also confirmed to have MERS.

All three members of this cluster recovered fully in less than two weeks. The report stresses however, that all were previously healthy and cases tend to be milder when discovered through contact tracing rather than patients who present to hospitals with acute symptoms.

In all, 115 contacts with the first patient were monitored, 5 contacts for the toddler and 24 contacts with the co-worker, totalling 144. None of these developed symptoms over the next ten days.

Saudi Arabia, Qatar Report New MERS Cases

August 23, 2013

Third MERS Case Reported in Qatar:
This announcement by The Center for Infectious Disease Research and Policy (CIDRAP) and Qatar's Supreme Council of Health states a third victim of the MERS Coronavirus is undergoing treatment and is in stable condition.

The 59 year old man had recently traveled to Saudi Arabia, which borders Qatar. In the two previous cases of MERS in Qatar, one man recovered and one later died in Britain.

The case was confirmed by the National Influenza Laboratory and all safety procedures for containment are being followed.  According to this report,
"Surveillance and monitoring procedures are being strictly followed and prompt measures taken for the infection control of all cases of acute respiratory infections, especially those coming back from abroad."
Saudi Reports Two New MERS Cases
The Saudi Ministry of Health, in a brief statement, reported two new cases of MERS and one previous victim which has passed away.

The new victims, located in Riyadh, are 50 and 70 years old, both with chronic pre-existing medical conditions.

CIDRAP reports these new infections bring the confirmed total MERS cases to 99, with 79 of those occurring in Saudi Arabia. So far, 48 people have died, 40 of those from Saudi Arabia.

Thursday, August 22, 2013

MERS Infected Bats Discovered in Saudi Arabia

Egyptian Tomb Bat
(image from The Rufford Foundation)
Health officials report an Egyptian Tomb Bat (Taphozous perforatus), native to the middle east, may be a point of origin for the MERS virus which has been spreading through the Arabian Peninsula and southern Europe, according to this report by the Center for Infection and Immunity (CII) at Columbia University's Mailman School of Public Health, EcoHealth Alliance, and the Ministry of Health of the Kingdom of Saudi Arabia.

The bats carried a type of MERS which is a 100% genetic match for the virus and was discovered near the area where the outbreaks were first reported in Saudi Arabia. Researchers believe that it may be the animal origin of the disease. They tested more than a thousand bats from seven different species. They believe another animal, an 'intermediate host', may be involved in spreading the virus from bats to humans. 

According to Ziad Memish, MD, Deputy Minister of Health, Kingdom of Saudi Arabia, and lead author of the study.
"There is no evidence of direct exposure to bats in the majority of human cases of MERS, Given that human-to-human transmission is inefficient, we speculate that an as-yet-to-be determined intermediate host plays a critical role in human disease."
In an attempt to locate the source of the deadly infection, scientists have been testing for the virus in a variety of wild and domestic animals. Recently, MERS was discovered in camels from the region, but the virus was not a perfect genetic match for MERS and most of those infected had no previous contact with camels.

In the next few days, the group is expected to release a report on MERS in camels, sheep, goats and cattle.


MERS Death Toll Rises; CDC Funds Increased Local Monitoring

August 21, 2013

Saudi Death Toll Rises to 76:
MERS virus (image from eden.lsu.edu)
The Saudi Health Ministry has announced that 76 people have died so far from the MERS virus which has health officials on alert in the Middle East, Europe and indeed worldwide. (EDIT: The source for this report may have mis-reported infection rates as deaths as these numbers are as yet, unconfirmed)

MERS (Middle East Respiratory Syndrome) was first reported in 2012 in isolated clusters on the Arabian Peninsula. It was still unknown if the virus could be transmitted by personal contact. At that time, there were about eleven known cases of the virus, five fatal.

Human to human transmission was confirmed in March, 2013 with the infection and death of a man in Britain. By then, the number of cases had increased to fourteen with eight fatalities. April and May saw a total of 23 infections in eastern Saudi Arabia.

The death toll rose as the disease spread, and by mid-August the numbers had jumped to nearly a hundred total confirmed cases with 46 fatalities. Saudi government officials now report the infection has claimed at least 76 lives in that country alone.

In a more optimistic sign, no new cases of MERS have been reported in Saudi since August 1, 2013 despite thousands of Ramadan pilgrims visiting the country during July and August. Countries are advised to be alert for signs of acute respiratory illness in people having recently returned from the area.

CDC Funds Efforts to Increase Local Monitoring:
The CDC (Center for Disease Control and Prevention) has awarded nearly 76 million dollars to assist state and local communities to beef up epidemiology and laboratories to better identify, track and respond to possible outbreaks of infectious disease. This is in addition to the 13.7 million dollars which was dispersed to local agencies in January, 2013.

The money will be used to hire more than a thousand full and part time epidemiologists, laboratory technicians and health information systems personnel. Noting that many outbreaks of infectious disease are first identified at the local level, the announcement states:
"The annual ELC investment provides public health officials with improved tools to respond to more outbreaks, conduct surveillance faster and prevent more illnesses and deaths from infectious diseases...This crucial CDC investment helps build a competent public health workforce, able surveillance systems, modern and efficient laboratory facilities and information networks."
More information on funding for specific states is available at this CDC website.

Originally published in Bits-n-Bytes: Technology Made Simple 

Worldwide Health Groups Issue MERS Updates

August 14, 2013

Middle East Respiratory Syndrome (Middle East Respiratory Syndrome Coronavirus, or MERS-CoV; aka Novel Virus) has been quietly spreading on the Arabian Peninsula. There have been nearly a hundred confirmed cases so far, half fatal. (See Deadly New Virus Spreads Through Human Contact)

MERS Coronavirus
Photo from HO-US National Institute for Allergy and Infectious Diseases
Several health organizations, including The Center for Disease Controls (CDC), The World Health Organization (WHO) and The European Centre for Disease Prevention and Control (ECDC) have issued new guidelines or updated information regarding the dangerous MERS virus which has killed 45 people in the Arabian Peninsula and southern Europe, with the majority of deaths in Saudi Arabia.

Increased Testing for MERS Recommended:
The CDC updated its advice to health professionals, advising them to increase testing for MERS, including in those who meet specific epidemiological and clinical criteria even if those illnesses could be explained by another cause. They also recommend testing for the virus in clusters of severe acute respiratory illnesses, even when there is no apparent link to other MERS infections.

Nations Watch for Outbreaks as Ramadan Pilgrims Return From Saudi Arabia:
To date, 94 cases have been laboratory confirmed, with an additional sixteen unconfirmed.The WHO reports that new infections are still occurring in the Arabian Peninsula but there have been no known exported cases for several months. They urge vigilance however, as thousands of Ramadan pilgrims have recently returned from Saudi Arabia. Ramadan ended on August 8.

Update 08/16/2013:
In a possibly ominous sign, a forty year old man in Mumbai, India is suspected of contracting the MERS virus after returning to India from 35 days in Saudi Arabia. He is currently quarantined at Kasturba Hospital in Chinchpokli while testing for the virus is being conducted. 

Update: 08/18/2013: The suspected case from India (above) has tested negative for MERS. He is responding well to treatment and will be released soon. 

Majority of Saudi Cases Spread Through Human Contact:
In response to a recent report that camels may be spreading the virus, the ECDC issued a statement cautioning that no clear link has been found. In fact, most of those infected had no known contact with camels or other animals.

Much of the spread of the disease appears to be through human contact. According to this article from the New England Journal of Medicine, 21 of 23 confirmed cases in Saudi Arabia were caused by person to person contact in three different health care facilities and among family care givers.

Originally published in Bits-n-Bytes: Technology Made Simple 


Camels Suspected of Spreading Deadly MERS Virus

August 10, 2013 
Camels have been shown to carry the MERS virus
image from http://www.cidrap.umn.edu
  • Camels are suspected to be carriers of Middle East Respitory Syndrome (MERS, previously called Novel Coronavirus) and may be responsible for some human infections.
  • MERS has sickened at least 94 people worldwide and claimed 46 lives.
According to this BBC report, infected camels may be capable of passing the virus to humans. Blood samples were taken from livestock worldwide. Antibodies to the virus were discovered in camels from Oman and Spain, suggesting the virus has become widespread in that region. Antibodies were not found in sheep, goats, cattle or other animals.

Originally published in Bits-n-Bytes:Technology Made Simple

Deadly New Virus Spreads Through Human Contact

March 9, 2013
MERS-CoV virus (Wikipedia article)

A previously unknown virus, nicknamed the 'Novel Coronavirus' has been blamed for the deaths of eight people and is capable of being transmitted directly through person to person contact.

The new virus, known as  HCoV-EMC, is from a family of coronaviruses which are responsible for the common cold and the SARS virus which killed more than 800 people worldwide during an outbreak in 2002 and 2003. It is genetically related to a type found in bats and the unusual virus seems to have mutated to a form which is capable of not only infecting humans, but alarmingly, can be spread from human contact alone.

The international medical community has been aware of the new illness since last year when it broke out in the middle east. At that time, eleven cases were reported including five deaths. Until now, it was unclear if the outbreak clusters were due to personal transmission or if they were all exposed to the same non-human source.

Now, the death of a man in Britain has ended all doubt. The BBC has reported the first cases of transmission of the Novel Coronavirus through close contact with an infected person. An ill man returning from Pakistan infected two of his sons. One later died, possibly complicated by a previous medical condition.

Officials in the UK have located all fellow passengers on the man's flight from Pakistan and are checking to see if any of those may have also been infected.

Currently there are only 14 known cases worldwide, with limited and clustered outbreaks reported in Saudi Arabia, Qatar, Jordan, and the United Kingdom. Eight of those victims have died.

Most of those sickened experienced severe lower respiratory symptoms with one instance of a mild infection where the victim recovered without medical treatment.

There are no travel restrictions currently in place, but the Center for Disease Control (CDC) is asking health professionals to report cases of acute respiratory infection in persons who have travelled to the Arabian Peninsula within the previous 10 days, or anyone who may have had close contact with persons who have recently returned from the Arabian Peninsula or neighbouring countries. More information can be found in this FAQ from the CDC.

Originally published in Bits-n-Bytes: Technology Made Simple

Image: coronaviruses 004 lores.jpg: http://commons.wikimedia.org/wiki/File:Coronaviruses_004_lores.jpg